title: A peculiar complication of suprapubic catheterization: recurrent ureteral obstruction and hydronephrosis.
abstract: BACKGROUND
  Suprapubic cystostomy (SPC) catheterization is a common and important technique for the management of vesicular drainage, especially in patients with neurogenic bladder. Some serious complications include bowel perforation and obstruction.
  
  
  RESULTS
  A 55-year-old man with C6 American Spinal Injury Association B tetraplegia and a urethral stricture requiring a chronic SPC was admitted for recurrent urosepsis. Computed tomography (CT) of the abdomen revealed severe right hydronephrosis and hydroureter due to obstruction of the right distal ureter by the SPC tip. The SPC (30 French/10-mm silicone catheter with a 10-ml balloon) was removed and replaced with a similar suprapubic catheter (30 French/10-mm silicone catheter with an 8-ml balloon). Symptoms recurred 2 months later and he was readmitted for urosepsis. CT of the abdomen again revealed severe right hydronephrosis and hydroureter due to obstruction of the right distal ureter by the SPC tip. The SPC was removed, and the patient was given a 14 French/4.67-mm urethral silicone catheter with a 5-ml balloon. Follow-up CT of the abdomen 2 months later showed complete resolution of the hydronephrosis and hydroureter. Of note, urodynamic studies 2 years earlier revealed an extremely small bladder with a capacity less than 20 ml.
  
  
  CONCLUSIONS
  This case illustrates that obstruction of the ureter by the tip of an SPC can be a cause of recurrent hydronephrosis and urosepsis.
authors.affiliation: Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA. boadeyemo@partners.org
authors.forename: Bamidele
authors.initials: B
authors.lastname: Adeyemo
authors.forename: Steven
authors.initials: S
authors.lastname: Makovitch
authors.forename: Dominic
authors.initials: D
authors.lastname: Foo
mesh_terms: D053715:Cystotomy / Q000009:adverse effects*; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery; D014546:Urinary Catheterization / Q000009:adverse effects*